HomeMy WebLinkAboutOwnerBuilder Affidavit`LLL
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Manning & DeveiVnci t Serwim Dqparmmt
l= ' L .tz F= - Building & Ca& RMalitions
ViVn6h Alper
L'°art 1'kr!r- emrida
{?73] 463-15M
OWNEWBUILDIF.RAFFMAVITDLSCLOS11R . STATEMENT
F.S. 489.10.3 (7) EXEfRP-nom
State law mqui m oerroruadon to he rdonc by liiewsed eonumewm You have ad4pliod for a p=it undeF an
a mption to that law- fila: excrnrttiom al law you, wi the rtwmr r of your jaatfrgoe ty, Lai =-L aq your 0wo c,)a&m w ev"
though you do rwt beve a lic 5 You mtL4 l a+w-3&—, dingy. on-site 4u t i.�ioa!t irf Lhc co ivicI n° ylaur�lf_ Yuu
iftu ,° h6ld or inirmy rc farm oulbuildirikk a orfe-lwuily iwr Evoi t fnrnily m -d denrcx far ya.rur wz and caceupa ncy. Yvnu
army a o build c°xt impmve a c;arrnrneruial hui Whig al a m!sL TmA t:xPxdiincg 575,(K,Kl,(kl arc kmg LL5 it i8 r4;rr 3,UkXr t1wn
au..% Or iy,yLvtta nuv. Yr u may nl1L hv,1d 937inprriwc mel 51WtUrC5 lb€ IhG P U1'9e1 ling pr 1rUWn.K JhLJL L JAWietg:
Yrau Tray Tena hire an unlicc pm,,Kn Ler ud ass yaxur w at actor or to super,-pevpLc - v%wkhig cc your bui].dii & Il
is ymr i-mgmsibiLity° Lo male sure &at people empbDyed by you hn-c liccnscs morel by suiw law and by guilty
or-murridpW H;=rmftcTdiJumcc&
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Initiial I ltrc_
if you sell x lease a building yraAl haw bralt or 6vkpA3vcd w•ilhin lame yrur aailer ti,rorUailm is kannplcle_ thorn it
prosumptiion is crest d than: it °wM bui IL arc imp>axved fur 3ole Lir Lam, which it; if violw3urp of fb s =cmPlion.
loihlal He tr.P4
You may eat aha di r'iar;cr r rvUnJ; work Lug -a Gid W[7trd7s -iAtv is not lid to perrkm
The w ark being deist_ Yraur rima ;Lr rftn murst omply wish all appliicablc hms, ordina bms, building cod , and
rarnIMggUIaiinms. Puuirud H
I urrlerbw7 d cWL lite buDdhig official and inspeetom am rant t}'acrc to d A ani ordive asdv:nx an I-I)w Iv mML the
mini,nuru wdc ]mKR1 lior;
I and acid ti= a� an c�wficl-buiiaicr LhaaL any ckmtr:act 4i*palcs wilt ,3ub-oxL[[wtm and l must be bOndiad in a c yil
coa n wel h thea avid ar;!n aama:,mey_ •alis 4qwnrmcV will not mitigate any CiL)rlt wt dhpubes_
Initial Here
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I nridi;r and Omt i 1161 a ornpmk=c Ley person or compww for wDTk pe farmod tlyc ° are required for be hearse i in this
jurisd[rdon. li' fcT same reascm the der mewl passwss a Lica nse, I may be respoasihk and liable for the.. cost of
I ,uaaJcr arui 1hAL if iamy pram Lh--al 6 unlice,ead and urian and �r s!s injured cm my ctrwimLikm prnj a --hey coaly he
Orlidi:d ter v vir'l r)tcM'N Lxwnprft%oLiun. I aaauld be held I 61 rice AL dkKLur, bswyer wart rehiled maxliral w3d, whigh
could irtcLuck kw. or ora &L-; during recav+ery In,m Lheir injury_ Initial herr-
•1•4 qualify for this C=Mfa€im wider chis alt swwntr 14Iarsl pt',Si7rrllV &f4 - sin &W build4 perMit
applrcahom and InibEO-the above
I hcrtby acknowk!,�r t al i himm read and undersiand flue: above &wdGsum strtommd mld that L iirrdxr understand
tbw Amy wolaaionof dx tams of the ownerebuilder ffkeanption shall be rcportcd k, the Building wmi 7 -wing
Depbrtmew to tk Florida S= Pcpartirwrit -of P"ro%miorial T aLlWiDIL q�C:ned acrd a&0owk40d Da this ,r X,
day of = gK41 of 20Z-01
)-AL IS
FbOMA r
CG'PJf*TTY OF
The fare eft i nsL merut was ackmawledk d LlePwc me 1hi.%; 4�f
' DpFl. 'ret : OecTor rre- whip is p i-SumUy known d0 Lne. 4M- J%tO leas
r KILILt5d a °VCr :c bra ¢ r. as id itLc tla a
hex afro:
'Si gn a i urt -o L� Type print Nam.- of Notary � l
Till: l hy[wv l'labrin f xnmissioD *lumber
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